Book of Medical Disorders in Pregnancy - Tintash

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cause progressive renal failure as the cysts become larger and the functioning renal parenchyma smaller in volume. This is the "Type III" cystic disease in the Potter classification, but it is rarely manifested prenatally or in children. Cystic change with obstruction: In the fetus and newborn with urinary tract obstruction, it is possible for cystic change to occur in the kidneys, in addition to hydroureter, hydronephrosis, and bladder dilation. Depending upon the point of obstruction, either or both kidneys may be involved. For example, posterior urethral valves in a male fetus, or urethral atresia in a male or female fetus, will cause bladder outlet obstructtion so that both kidneys are involved. With bladder outlet obstruct-tion, there will be oligohydramnios and the appearance of pulmonary hypoplasia. N Grossly, this form of cystic disease may not be apparent. The cysts may be no more than 1 mm in size. Microscopically, the cysts form in association with the more sensitive developing glomeruli in the nephrogenic zone so that the cysts tend to be in a cortical location. Thus, "cortical microcysts" are the hallmark of this form of cystic disease, which is "Type IV" in the Potter's classification. There are no accompanying cystic changes in other organs in association with this disease. Congenital neoplasms: Such tumors are uncommon, but those that are seen most frequently include: Teratoma. These tumors occur in midline regions (sacrococcygeal, cerebral, and nasopharyngeal). Nasopharyngeal teratoma, gross: Tera-toma, low power microscopic and immature teratoma, medium power microscopic. Hemangioma. About 1/3 of all soft tissue neoplasms in the first year 203 of life are hemangiomas or lymphangiomas. Fibromatoses are also comon. Hemangioma, gross and Hemangioma, microscopic. Neuroblastoma. The incidence of congenital neuro-blastoma is 1:8000. Neuroblastoma, gross. Neuroblastoma, microscopic. Size and location are important, for even histologically benign neoplasms can obliterate normal tissues, be difficult to resect, or recur with incomplete resec-tion. Malignant neoplasms have the capacity for invasion and metastases. Skeletal abnormalities: Ultrasound may reveal long bones that are short-ened. There are several possibilities, including short limbed dwarfism, osteogenesis imperfecta, and short rib polydactyly syndrome. The various forms of short limbed dwarfism, which can be lethal, are more difficult to diagnose specifically. The features of these various conditions may not be well developed at 20 weeks gestation or less, making diagnosis more difficult. Limitation of survival is often due to pulmonary hypoplasia because the chest cavity is too small. Achondroplasia is a form of short-limbed dwarfism that is inherited in an autosomal dominant fash-ion, though in most cases there is no affected parent and the disease is due to a new mutation. The homozygous form of the disease is lethal. The heterozygous form is not lethal, and affected persons can live a normal life. They have short extremities, but a relatively normal sized thorax and normal sized head. Thanatophoric dysplasia (TD) is a lethal condition. The long bones are short and curved, with femora that have a "teleph-one receiver" appearance on radiograph because of the curvature. The vertebrae
have marked platyspondyly with widened disc spaces. There are two forms, TD 1 and TD 2, with the latter distinguished by the appearance of a "cloverleaf" pattern to the skull. Osteogenesis imperfecta occurs in several forms. There is a lethal perinatal form in which fractures appear in long bones even in utero. This condition is due to an abnormal synthesis of type 1 collagen that forms connective tissues, including bone matrix. Thanatophoric dysplasia, radiograph and osteogenesis imperfecta, radiograph. Placental abnormalities: Abruptio placenta: Premature separation of the placenta near term, with retroplacental blood clot. Abruptio placenta, gross: Placenta previa: Low lying implantation site can lead to hemorrhage during delivery. Velamentous insertion: Cord vessels splay out in the membranes before reaching the placental disk and predispose to trau-matic rupture. Velamentous insertion, gross, long short cord: Umbilical cord length is determined by the amount of fetal movement. More movement in-creases cord length. A long cord can become entangled with the baby or more easily prolapse. Nuchal cord, gross, true knot of umbilical cord, gross and twin placenta: Monozygous twinning is associated with increased risk for both abnormalities and accidents. A twin transfusion syndrome can occur when a vascular anastomosis is present: Vascular anastomosis in placenta, gross, vascular anastomosis in placenta, gross and hypertension: Vascular changes can be associated with pregnancy induced hypertension (PIH) and the more severe 204 complications of eclampsia and preeclampsia. Decidual arteriopathy, microscopic. REFERENCES: 1. J.S. Dashe, D.M. Twickler, R.Santos- Ramos, D.D. McIntire, R.M. Ramus. "Alpha-fetoprotein Deduction of Neural Tube Defects and the Impact of Standard Ultrasound" American Journal of Obstetrics and Gynecology,2006; 195(6): 1623-1628. 2. ^ R.H. Ball, A.B. Caughey, F.D. Malone, D.A. Nyberg et al. "First and Second Trimester Evaluation of Risk for Down Syndrome" Obstetrics & Gynecology,2007; 110(1): 10-17. 3. J.L. Maron , G. Alterovitz, M.F. Ramoni, K.L. Johnson, D.W. Bianchi. "High-throughput Discovery and Characterization of Fetal Protein Trafficking in the Blood of Pregnant Women" Proteomics Clinical Applications,2009; 3(12): 1389-1396. PMID: 20186258. 4. Santiago Munne, INCIID - accessed July 18, 2009 5. Imudia AN, Kumar S, Diamond MP, DeCherney AH, Armant DR (April 2010). "Transcervical retrieval of fetal cells in the practice of modern medicine: a review of the current literature and future direction". Fertil. Steril. 93 (6): 1725–30. doi:10.1016/j.fertnstert.2009.11.022. PMID 20056202. 6. European Biotech Company Biocell Center Opens First U.S. Facility for Preservation of Amniotic Stem Cells in Medford, Massachusetts | Reuters". 2009-10-22. Retrieved 2010-01-11. 7. ^ "Europe's Biocell Center opens Medford office - Daily Business Update - The Boston Globe". 2009-10-22. Retrieved 2010-01-11. 8. ^ "The Ticker - BostonHerald.com". Retrieved 2010-01-11.
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MEDICAL DISORDERS IN PREGNANCY M. S
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PREFACE Almost all medical disorder
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Dedication This manuscript is dedic
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Uri. Elkayam MD Professor of Cardio
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Chapter No: 1 Anaemia in pregnancy:
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performance. Tiredness, listlessnes
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pregnancy and labour. The monthly b
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Fig 1.3: Shows developmental stages
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Prophylactic this includes routine
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granulocytes and thrombocyte is als
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or because the hemoglobin A is repl
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iron. Decrease in the number of gra
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Labor/delivery: Expedite for normal
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Risk factors: The risk of GDM incre
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to a large extent on the measure of
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vomiting, or through intercurrent i
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largely related to the problems of
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femoral epiphyses can help in asses
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in a randomized design the efficacy
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of the previous day’s dose of ins
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women with vascular disease are awa
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Chapter No 3 THYROID DISEASE IN PRE
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such as phenobarbitone 30 mg given
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REFERENCES: 1. Hawe, P. and Francis
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Incidence - Its incidence varies ac
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cerning the disturbance in the Reni
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Renal function: In normal pregnant
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severe pre eclampsia and eclampsia
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Epipastic pain: It is also a late s
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arely occurs. However, if pregnancy
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differentiating between chronic hyp
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fetuses. Recent studies indicate th
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to procrastinate all available meth
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cases are said to occur up to 1 wee
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has been carried out. There can be
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intensive care room for the next 48
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Severe pre eclampsia at or remote f
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Chapter No: 5 HEART DISEASE IN PREG
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pregnancy. The increase in volume i
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Fourth Heart sound - This is rarely
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Class III - With cardiac disease pr
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differentiate from hemodynamically
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dominant). Jervell + Lange Nielson
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striking of which is stippling seen
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increase venous pressure and burden
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determine whether she will be safe
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supplemental 02. Fetal surveillance
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11. Percutaneous transluminal angio
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ureter at the pelvic brim may play
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Fig6.3: Shows location of kidney in
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A clear cut history of streptococca
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(a) Polycystic renal disease - Fort
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with patients in this category. In
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2. Beard, R.W.and Roberts, A.P. (19
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increases slightly. Arterial blood
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scan, 0.004 Gy; pulmonary angiograp
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CD4 + cell count (200/ml) should re
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embark upon a pregnancy. Severe air
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Chapter No: 8 LIVER DISEASE IN PREG
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owel, but conjugated bilirubin is n
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Hepatic causes - Viral hepatitis bo
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Immunoprophylaxis at birth followed
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highest reported rate of vertical t
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curs in 60 to 70 percent of subsequ
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Chronic liver disease: An increased
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22. Riely CA. Hepatic disease in pr
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ilirubin is transported across the
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when the titre is greater than 1: 3
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Induction of labour: When screening
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Blood brain barrier and bilirubin e
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place if the infant develops jaundi
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REFERENCES 1. UpToDate a. “Pathog
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of embolus formation is far less in
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Unfortunately this faculty is not a
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hours. The maximal effect takes 36
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may complain of constricting type o
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When the embolus is small and non f
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3. Sukal S, Geronemus R. "Deep Veno
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damage specific cells in the tissue
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is capable of breaking off and deve
Page 162 and 163: Chapter No: 12 PARASITIC INFECTIONS
Page 164 and 165: sporozoite stage. The main characte
Page 166 and 167: insect repellents and insecticide s
Page 168 and 169: is 2 tablets i.e. (400 mgs) thrice
Page 170 and 171: Cardiac failure resulting from seve
Page 172 and 173: dysmenorrhea, dysuria, and even obs
Page 174 and 175: Chapter No: 13 VIRAL DISEASES IN PR
Page 176 and 177: after exposure favors but does not
Page 178 and 179: Fig13.4: shows CMV infection rash o
Page 180 and 181: three quarters of HYH strains isola
Page 182 and 183: where 'T' stands for toxoplasmosis
Page 184 and 185: Chapter No: 14 Introduction: The dr
Page 186 and 187: hexacyanoferrate (II) 2H2O (Prussia
Page 188 and 189: Restricted indications: Anti lepros
Page 190 and 191: potential Teratogen and inhibits ma
Page 192 and 193: placental abruption, and intrauteri
Page 194 and 195: Inhalation of volatile organic comp
Page 196 and 197: Chapter No: 15 Pregnancy is a norma
Page 198 and 199: time periods during the pregnancy f
Page 200 and 201: y the maternal kidney in urine or b
Page 202 and 203: continues after the end of the uter
Page 204 and 205: Amniography - In this technique rad
Page 206 and 207: at the cranial end of the neural tu
Page 208 and 209: least maceration: placenta, lung, a
Page 210 and 211: fetal hydrops with monosomy X, or T
Page 214 and 215: 9. Papageorgiou, E.A.; Karagrigorio
Page 216 and 217: position of the head. The student s
Page 218 and 219: centimeter ruler is placed alongsid
Page 220 and 221: echoes in B mode. The operator appl
Page 222 and 223: also affects depth resolution and t
Page 224 and 225: From twelve week onwards the bipari
Page 226 and 227: tract. Normal kidneys can easily be
Page 228 and 229: 3.19, 1.29 and 1.30, respectively [
Page 230 and 231: iodinated contrast during pregnancy
Page 232 and 233: Only tiny amounts of iodinated or g
Page 234 and 235: intraperitoneal hemorrhage, or inju
Page 236 and 237: REFERENCE: 1. Stewart A, Webb J, Gi
Page 238 and 239: cardiac defects 181, 200 cardiac di
Page 240 and 241: gestational age 26, 31, 40, 165, 19
Page 242 and 243: monitoring, invasive 83-6 monosomy
Page 244 and 245: sensitization 124-5 sepsis 22, 95-6
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